N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-4.13

Current through Register Vol. 46, No. 51, December 18, 2024

Section 86-4.13 - Groupings

(a) For the purpose of establishing reimbursable operating costs, facilities shall be compared on the basis of the following general criteria:

(1) similarity of services; and

(2) regional economic factors.

(b) Comparisons using similarity of services shall be based on the following:

(1) Comprehensive primary medical care services shall mean those health care services organized to provide basic medical care to the general population without regard to patient category or characteristics such as health status, diagnosis, age or sex. Such primary medical care services shall be provided by staff sufficient in number and capable of delivering comprehensive primary medical care services. A facility providing comprehensive primary medical care services as its principal mission shall be categorized as a comprehensive primary medical care facility.

(2) Limited primary medical care services shall mean those health care services organized to provide basic medical care to a population of individuals with a specific medical condition or dysfunction. Such primary medical care services focus on the medical care needs of this population that are incidental to, interrelated with or a consequence of the specific primary medical diagnosis/disease process. When limited primary medical care services are not the principal mission of a facility, the facility providing limited primary medical care services shall be categorized based on the services, as defined in this section, which it provides as its principal mission and shall not be categorized as a comprehensive primary medical care facility.

(3) Family planning services shall mean those services organized to provide reproductive and/or gynecological related health care services to men and women of reproductive age. A facility providing family planning services as its principal mission shall be categorized as a family planning facility.

(4) Abortion services shall mean those services related to the termination of pregnancy including services associated with verification of the pregnancy, abortion counseling services and post-procedure examinations. Sterilization procedures done as outpatient surgery shall be included in this category as well. A facility providing abortion services as its principal mission shall be categorized as an abortion facility.

(5) Developmentally disabled services shall mean those services organized to provide ongoing/long-term rehabilitation therapy services to individuals with developmentally related physical disabilities. A facility providing developmentally disabled services as its principal mission shall be categorized as a developmentally disabled services facility.

(6) Rehabilitation therapy services shall mean those services organized to provide episodic or short-term restorative therapy services to individuals physically disabled from causes that are predominantly other than developmentally related. A facility providing such rehabilitation therapy services as its principal mission shall be categorized as a rehabilitation therapy facility.

(7) Speech and hearing services shall mean speech/language pathology and audiology services. A facility providing speech and hearing services as its principal mission shall be categorized as a speech and hearing facility.

(8) Dental services shall mean those services organized to provide basic dental care to the general population. A facility providing dental services as its principal mission shall be categorized as a dental facility.

(9) Dialysis services shall mean hemodialysis, peritoneal dialysis and home dialysis services provided to patients with chronic renal disease. A facility providing dialysis services as its principal mission shall be categorized as a dialysis facility.

(10) Optometric services shall mean optometry and services related to eye and vision care. A facility providing optometric services as its principal mission shall be categorized as an optometric facility.

(11) Methadone maintenance treatment services shall mean drug detoxification and drug dependency counseling and rehabilitation services which include chemical management of the patient with methadone. A facility providing methadone maintenance treatment services as its principal mission and certified by the Office of Alcoholism and Substance Abuse Services shall be categorized as a methadone maintenance treatment program (MMTP) facility.

(12) Drug free services shall mean drug dependency counseling and rehabilitation services, including incidental and interrelated medical care services, provided in a drug free environment. A facility providing drug free services as its principal mission shall be categorized as a drug free facility.

(13) Child health services shall mean acute, episodic, preventive and well child care services, including immunizations, provided to the pediatric population. A facility providing child health services as its principal mission shall be categorized as a child health facility.

(14) A county sponsored facility which does not provide comprehensive primary medical care services but provides health care services such as dental, well child care, immunizations, TB services, STD services, and prenatal and/or other reproductive related health care services shall be categorized as a county sponsored multiservice facility.

(c) Regional economic factors shall be defined to mean significant differences in labor cost experienced by facilities that are due to their geographic location and which impact on the delivery of patient care services.

(d) For the purpose of comparison, when there are fewer than three facilities defining a particular category of service as their principal mission, the facilities will be treated as ungrouped until such time as there are at least two other similar facilities.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-4.13